Title V and Title XIX (KDHE Division of Health Care Finance/Medicaid) are working to identify and address disparities among Medicaid beneficiaries. A strong focus has been on use of the Medicaid-linked birth data set and areas where measures and programming align, such as disparities in prenatal care and birth outcomes. Title V assists Medicaid to identify and address reporting and other program requirements related to childhood immunization status, live birth weight, well child visits, and chlamydia screening.

Title V-Title XIX Intra-Agency Agreement (IAA)

The Title V-Title XIX IAA, established in 2016, outlines the formal partnership. The partnership has evolved over the years but not grown and strengthened to the level needed. The agreement was reviewed in 2019 and amended to further define and detail the relationship between Title V and XIX as it relates to Maternal Mortality Review. The amendment resulted in direct access to data needed to conduct case reviews.

Although communication has improved and progress has been made, there have been delays with implementing and advancing aspects of the Medicaid alignment, integration, and data sharing. These very real challenges are likely due to significant and repeated changes in leadership positions (Secretary, State Health Officer, Health Care Finance Division Director, Medicaid Director, Medicaid Medical Director) since December 2017. The Medicaid Director and Secretary changed again in January 2019; the Medicaid Medical Director and Medicaid Director (again) in May 2020. A new Medicaid Director was named in July 2020 and Division Director shortly after in 2020. The Medicaid Medical Director remains vacant. Despite the past challenges and recent events (key vacancies, COVID-19 pandemic), agency leadership continue to embrace, understand, and support the need for increased collaboration and communication, including data sharing. Overall, the IAA has potential but isn’t fully operationalized or institutionalized.

A crosswalk of Title V and Title XIX priorities and measures was included in the IAA to show alignment potential; the alignment was updated in June 2021. A crosswalk of the adult and children’s CMS quality measures was also completed to support stronger partnerships between the two programs.  (partial document screenshots below).

Title V-Title XIX Partnership Impacts

Title V continues to build on activities and progress that have provided a strong foundation for the partnership. Key activities have reduced some barriers and paved the way for a new precedence of partnership, data sharing, and collaboration.

There are several initiatives that will continue to be pursued to advance systems of care for the MCH population. The slide below outlines some of the current work with status related to key policy areas.

Kansas Pediatrics Supporting Parents (PSP)

In partnership with the Phase 1 PSP team and national consultants, a new policy was implemented to cover maternal depression screenings under the child’s plan. PSP Phase 2 goal is to “Improve young children’s social and emotional development in pediatric primary care by strengthening care coordination practices delivered through Kansas Medicaid.” There were three project focus areas: Systems Alignment, Payment Policy, and MCO Contract Procurement. Title V remains involved in discussions for each these areas, despite formal project support ending in December 2020. The team developed a timeline spanning from 2020 through 2022.

Community Health Workers & Medicaid

Title V continues to support Phase 2 PSP recommendations through avenues such as the expansion of community health workers (CHWs), known to effectively address social determinants and health disparities. In partnership with United Methodist Health Ministry Fund (UMHMF), a cross-agency “steering committee” and broader “work group” has been convened to focus on credentialing and payment policies for CHWs. The Bureaus of Family Health and Health Promotion (BFH and BHP) represent KDHE on these groups.

CHWs support individuals by connecting them to the information and services needed for optimal, individualized health outcomes. Established by the Kansas CHW Coalition the following Scope of Practice (SOP) outlines roles and responsibilities of CHWs.

This scope is distinctly aligned with the model supported through Title V public health, referred to as holistic care coordination (HCC). These initiatives (i.e., PSP, CHW credentialing/policy, HCC) share the following objectives:

• Create a system of care for all families to receive supports in navigating health, community, social, and family needs.
• Create a pathway for a high quality, trained workforce to provide these supports (e.g., training, credentialing).
• Establish policies to assure adequate reimbursement to provide these services to families across systems.

Through this work, Kansas is drafting a policy memo for short- and long-term payment strategies, credentialing, and Medicaid procurement. BFH and BHP are partnering to support a cohesive and integrated approach that show the intersection of work in the state around care coordination. As a supplement to this policy memo, a robust and collaborative Medicaid payment policy will be included that allows for payment of care coordination, as a service line, for various provider types (including CHWs, home visitors, and other care coordinators) in both public and primary care settings. It is anticipated to include existing Medicaid services under the “Care Coordination” service through OneCare Kansas (OCK), the legislatively mandated health homes initiative. Per the OCK Program Manual, Care Coordination is done through “appropriate linkages, referrals, coordination, collaboration, and follow-up for needed services and support.”

In addition to the policy recommendations outlined in the memo, the team intends to focus on the recommendations from the PSP work, to “Amend the Contract to Address Service Coordination for Preventive Care.” Title V is currently monitoring progress on re-procurement  to support public health’s role in amending the RFP to reflect that MCOs must provide service coordination to all enrollees, considering national standards aimed at pediatric populations for care coordination.

Other Title V-Title XIX Activities

Navigating Kansas Medicaid & the Insurance System: Local MCH agencies assist clients in navigating insurance systems (public/private/Medicaid). Many facilitate on-site enrollment of MCH clients and screen for insurance status/coverage at each encounter. If uninsured, Medicaid eligibility is reviewed and a referral is made, when appropriate. Staff assist individuals/families to complete the application and submit to Medicaid, when needed. For those who do not qualify for Medicaid, private Marketplace information is provided along with contact information to a Navigation Specialist.

Kansas Special Health Care Needs (KS-SHCN): KS-SHCN works collaboratively with Medicaid/MCO to assure dually enrolled clients receive appropriate services and quality case management/care coordination (addressed in the IAA). MCOs share data monthly around authorized Medicaid services to the KS-SHCN Care Coordinator, allowing them to assist clients in getting appointments scheduled, fill prescriptions, communicate with providers, and other supports. KS-SHCN coordinates with MCO care coordinators around gaps or barriers in services. KS-SHCN routinely presents to the MCOs and Medicaid partners to discuss varies challenges in meeting the needs of the SHCN population.

MCH Opportunity Project: The MCH Opportunity Project focuses on targeting health inequities at the local/community level. One of the participating communities has determined their project will be focused on hiring and training additional health care navigators who will focus on enrolling pregnant and postpartum women in Medicaid or other available health plans. Their strategy includes targeted outreach and education at community events and through partnerships with allied organizations – meeting pregnant or postpartum persons where they are and ensuring they have covered care during a critical and high-risk period.

CMS Improving Postpartum Care Affinity Group: Kansas is one of nine states/teams participating in collaborative learning with staff from the Centers for Medicare & Medicaid Services, quality improvement (QI) advisors, and subject matter experts (SMEs) in improving postpartum care. The goal of this effort is to improve postpartum care visits and the quality of visits among Medicaid and the Children’s Health Insurance Program (CHIP) beneficiaries. While the Kansas team, led by Medicaid staff, is still working on defining specific goals, measurements, and outcomes, the BFH team is involved to ensure alignment with related efforts, specifically the Fourth Trimester Initiative guided by the Kansas Perinatal Quality Collaborative (KPQC) and aimed at reducing severe maternal morbidity and maternal mortality.